The purpose of the project is to determine the incidence rates, rates of progression, and risk factors for the chronic complications of NIDDM. The study is conducted in the Pima Indians of the Gila River Indian Community, who have participated in a longitudinal epidemiologic study since 1965 (see project Z01 DK 69000). Risk factors for the major complications of diabetes, retinopathy, nephropathy, coronary artery disease, and peripheral vascular disease are determined by longitudinal followup of diabetic subjects. Methods of ascertainment of these complications include fundus photography, measurement of urine albumin and serum creatinine concentrations, electrocardiography, and documentation of lower extremity amputations. The incidence of elevated urinary albumin excretion in Pima Indians with NIDDM is at least as high as that reported in IDDM, and its major risk factors (retinopathy, type of diabetes treatment, longer duration of diabetes, lower body mass index, and higher values of mean arterial pressure, glycated hemoglobin, and fasting and two-hour post-load plasma glucose concentrations) are the same as those shown previously to predict the development of more advanced renal disease in this population. Diabetic subjects with peripheral neuropathy had slightly higher age-sex adjusted mortality rates from all causes and a 2.2-fold increase in mortality rates due to renal causes compared with diabetic subjects without neuropathy. These findings are consistent with the hypothesis that peripheral neuropathy is associated with autonomic neuropathy and impaired renal autoregulation, which may predispose to glomerular injury.